The Postnatal Client Overview Guidelines

1. The Postnatal ClientOverview Guidelines • Presented by Cherry Baker

2. Postnatal periods • It is illegal to return to work within 2 weeks of delivery • Early postnatal period 0 – 6 weeks • Full postnatal period 6 weeks to 12 months

3. Have you stopped bleeding? 2. Have you had your postnatal check? Do not accept in class if still bleeding chance of air embolism or haemorrhage Client should not return to a main stream class until they have had their postnatal check Postnatal ScreeningIt is important you ask the following specific questions to ensure the class is suitable for your client:

4. 3. How old is your baby? 4. What type of delivery did you have? 5. Do you feel well? Do you have any joint pain? 7. Are you breast feeding? Don’t accept without postnatal check C- sections may take longer to recover surgery is super imposed on childbirth. Scarring & loss of feeling Client should not feel ill or feverish Check for back / sacroiliac pain. Consider calorie and hydration implications Rec Check Postnatal Screening Cont….

5. Benefits of Postnatal Exercise Thecorrecttype of exercise in the postnatal periods may: • Promote circulation and aid repair • Maintain energy levels • Aid physical recovery • Aid psychological recovery • Aids symptoms of mild postnatal depression • Aid recovery of the abdominal area • Repair pelvic floor prevent prolapse and stress incontinence • Prevent or improve back and sacroiliac pain • Aid weight reduction • Lessen recovery time • Ability to cope with new born

6. Adaptations • Carpal Tunnel • Pelvic Girdle Pain • Abdominal weakness and stretch • Breast feeding

7. Abdominal Separation • It is the linea alba that thins rather than ‘splitting’ • Gap between muscles due to excessive lengthening & influence of pregnancy hormones or labour • Specific transitions getting up and down from step & lifting weights needs extra care • Avoid direct work on rectus abdominus till the gap is two finger widths or less

8. Testing for Diastasis • Postnatal-2 finger gap • Test below and above the belly button • Support during the sit up phase • Protect modesty • Self testing

9. Factors affecting Stability in the postnatal phase • Posture • Lots of bending, lifting and sitting • Centre of gravity changes • Stretched abdominal muscles • Round and broad ligaments stretched • Diastasis • Lengthened glut max and med

10. Core Stability • Transversus / internal oblique's • Pelvic floor • Multifidus

11. Facia • Connective tissue • Thoracolumbar facia • Sacral Facia • Facial lines

12. Core Stability • Deep and superficial muscles • Back pain can occur due to the spine being able to ‘wobble’ through lack of stability • Correct movement patterns • Correct muscle balance • Deep muscles restrict unwanted or excessive movement

13. Trunk stability against limb loading Standing stability! Focus on pelvic stability – lumbar pelvic rhythm and lifting techniques

14. Abdominal Repair • Teach abdominal hollowing • Challenge abdominal hollowing against limb loading • Abdominal hollowing and posterior tilt • Abdominal hollowing, posterior tilt and sit up activity • Teach correct lifting • Teach good posture thoracic and lumbar extension • Shoulder and pelvic stability

15. Shortening within the inner range • Shorten within the inner range • Abdominal hollowing • Maintain hollowing & pelvic tilt • Maintain abdominal hollowing add pelvic tilt & thoracic flexion • Combine the above and lift into the inner range • Muscle balance from lower fibres of rectus to upper fibres of rectus

16. Setting up classes • NCT • Local Community midwifes • Doctors surgery • Health visitors • Friends who are pregnant • TIME!!

17. Contacts • Local maternity hospital • Community midwifes • NCT • Guild of postnatal teachers